Chalermchockcharoenkit Amphan, Culnane Mary, Chotpitayasunondh Tawee, Vanprapa Nirun, Leelawiwat Wanna, Mock Philip A, Asavapiriyanont Suvanna, Teeraratkul Achara, McConnell Michelle S, McNicholl Janet M, Tappero Jordan W
Departments of 1Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Infect Dis. 2009 Jul 15;49(2):299-305. doi: 10.1086/599612.
World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B.
Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare).
Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, P = .002 for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038).
The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
世界卫生组织关于预防1型人类免疫缺陷病毒（HIV-1）母婴传播的指南建议，对于未因自身健康问题接受治疗或无法采用复杂治疗方案的HIV-1感染女性，给予齐多夫定和单剂量奈韦拉平（NVP）。本研究评估了泰国接受单剂量NVP的HIV感染女性和婴儿的抗逆转录病毒耐药模式，泰国主要流行的HIV-1毒株是CRF01_AE重组体，少数是B亚型。
采集静脉血样本，来自（1）从妊娠34周开始接受齐多夫定、分娩时接受单剂量NVP加口服齐多夫定的HIV感染女性，以及（2）出生后接受单剂量NVP加分娩后4周齐多夫定治疗的HIV感染婴儿。使用TruGene检测法（拜耳医疗保健公司）进行HIV-1耐药性检测。
大多数母亲和婴儿感染的是CRF01_AE。在190名女性中有34名（18%）和10名婴儿中有2名（20%）检测到NVP耐药。分娩时病毒载量>50,000拷贝/mL的女性中NVP突变比例显著更高（调整优势比，8.5；95%置信区间，2.2 - 32.8，线性趋势P = 0.002），以及感染B亚型而非CRF01_AE的女性中（38%对16%；调整优势比，3.6；95%置信区间，1.1 - 11.8；P = 0.038）。
与感染B亚型的母亲相比，感染CRF01_AE亚型的母亲中NVP突变频率较低，这表明感染CRF01_AE亚型的个体可能比感染B亚型的个体更不易诱导产生NVP耐药。
